Free Dorsal Toe Flap for Reconstruction of the Hallux

Soft tissue defects of the hallux represent a reconstructive challenge. Traditional options include regional flaps based on the first dorsal metatarsal artery (FDMA). However, the resultant bulky neo-hallux and contouring defect of the donor site are significant limiting factors. Here, we present the case of a young male athlete who underwent successful reconstruction of a dorsal defect of the hallux, with open exposed joint, using a free flap from the contralateral toe. We believe this is the first report of a free dorsal toe flap to reconstruct a defect of the hallux. The flap was based on the lateral dorsal digital artery, an extension of the FDMA. The donor site was reconstructed using a full thickness skin graft from the groin. Postoperatively, the flap survived completely, and both the recipient and donor sites healed without complication. There was no contour abnormality and he was able to wear his normal shoes and ambulate normally by week 3. Although the dorsal metatarsal artery perforators that supply the dorsal skin of the forefoot have been well described, there have been limited studies investigating the vascular supply of the dorsal skin overlying the hallux distally. Our experience shows that it is possible to raise a free dorsal toe flap based on the lateral dorsal digital artery only. This flap represents the ideal like-for-like reconstruction for soft tissue defects of the hallux.